Perspectives on Diabetes Care

Tips on Smoking Cessation

Aug 9, 2013, 01:00 AM

I smiled when I saw a familiar face, Tami Ross, AADE President, welcoming us to the AADE Annual Meeting as I watched from home via the Virtual Meeting this year. Tami lives in Lexington, KY with me and I’m just so proud of so many of our diabetes educators from the Lexington area who are in leadership positions in AADE. She did this cute “Rocky” inspired video on those famous steps in Philly to “get ready” for the annual meeting. Tami has always been so personable and creative and it was fun to see her do something different as part of her opening address.

I watched Phil Southerland discuss his Team Type 1 and his journey with Type 1 diabetes. I remember Phil coming to some of our ADA Diabetes Walk events year ago and is glad he is still very involved and advocating for patients with diabetes across the globe.

Then, I watched the breakout session on Tobacco Dependence: The Importance of Motivational Interviewing and Medications. I refer patients to our local Cooper Clayton Smoking Cessation classes and had not really worked with someone trying to quit recently so I thought it would be a good update.

Some of the tips I took away:

• Encourage your patients to have a ‘quit jar’ where they put at least 50 cents in there for every pack that they purchase to save for nicotine replacement therapy (NRT). Ideally, you would have them put the average price of a cigarette pack ($5.51), but most patients can not afford that so she said that 50 cents was a ‘doable’ amount for most patients. She also encourages her patients to decorate the jar.
• Diabetes educators are in an ideal position to influence the patient to stop smoking since patients visit us more than their doctors. Studies have shown that patients receiving even just a little advice to help quit smoking had greater success.
• Do not cut the patch when titrating dosage. Patients are tempted to just cut their patch in half when moving from a 14mg dose to a 7mg dose. This causes problems with the patch either dumping out too much or becoming less effective.
• Acidic beverages (like juice, soda, and coffee) decrease absorption of nicotine so it is recommended to not eat or drink 15 minutes before or during NRT. She explained that many of her patients will frequently have a cigarette with coffee and she tells them to go ahead and chew their nicotine gum even though they may get less nicotine. If they skip the gum, then they will get none and break the habit of NRT.
• How you chew the NRT gum is very important since it is not chewed like regular gum. If it is chewed like regular gum, someone could have a lot of stomach problems. The proper technique is to chew it slowly and then leave it between cheek and gum for slow absorption. Then, when tingling is gone, slowly chew again moving around the mouth until the taste is gone.
• For most of her patients, she likes the patch and then gum as needed for cravings.
• If someone chews up the nicotine lozenge, they do not get the nicotine so it is important to remind patients to not chew it.
• If a patient starts taking Buproprion (Zyban) and if they don’t see progress after 7 weeks, it should be stopped since it is not working for them. If they have behavioral changes or suicidal thoughts, they should seek help immediately.
• Use motivational interviewing when working with patients to quit smoking. Ask them to think about when they were successful for just making a small change and apply so of those same principles to quit smoking.

I think many times, we as educators may think that smoking cessation may be out of our realm since it is not necessarily directly related to diabetes. However, we are in an ideal position to initiate and support the person who is thinking about changing and refer them to greater support systems.